Problem 3 - Clinical Nursing Skills and Techniques

Question

A patient is to receive medications through a gastrostomy. Which nursing actions are appropriate? (Select all that apply.) 1 Verifying tube placement after medications are given 2 Mixing all crushed medications together and give all at once 3 Flushing tube with cold water after giving medications 4 Flushing tube with 30 to \(60 \mathrm{~mL}\) of water after the last dose of medication 5 Checking for gastric residual before giving the medications 6 Keeping the head of the bed elevated 30 to 60 minutes after the medications are qiven

Step-by-Step Solution

Answer

Appropriate actions: 4, 5, and 6.

Step 1: Verifying Tube Placement

Appropriate nursing practice involves verifying the placement of the gastrostomy tube before administering any medications. This ensures that the tube is correctly positioned in the stomach, preventing complications like aspiration or improper absorption of medications. Since the action involves checking tube placement before administering the medication, option 1 is inappropriate.

Step 2: Mixing Medications

Crushing and mixing all medications together is generally not recommended, as it can cause chemical reactions between medications and affect their effectiveness. Each medication should be given individually unless directed otherwise by a professional. Therefore, option 2 is inappropriate.

Step 3: Flushing the Tube with Temperature Consideration

Cold water can cause discomfort when used to flush the tube. Using room temperature water is the best practice. Thus, option 3 is inappropriate as it suggests using cold water.

Step 4: Flushing the Tube with 30-60 ml of Water

It's critical to flush the gastrostomy tube with 30 to 60 ml of water after administering the last dose of medication to ensure that all medication has been delivered and the tube is cleared to prevent blockages. Therefore, option 4 is appropriate.

Step 5: Checking for Gastric Residual

Checking for gastric residuals before administering medications helps to evaluate the patient's ability to process feeding and ensures that the stomach is not overly full. Therefore, option 5 is appropriate.

Step 6: Positioning After Administration

Keeping the patient's head elevated 30 to 60 minutes after medication administration helps prevent reflux and aspiration. Thus, option 6 is appropriate.

Key Concepts

Tube Placement Verification

Before administering any medication through a gastrostomy tube, it is crucial to verify that the tube is in the correct position. This step is essential for ensuring patient safety and the proper delivery of medication.

• Why it matters: Checking the position prevents complications such as improper medication delivery or aspiration into the lungs, which can lead to serious health issues.


• How to verify: Common methods include aspirating stomach contents to check their pH, checking external measurements, or using specialized devices if available.

This step should be done before giving medications to confirm that the tube has not shifted since the last verification. Failure to confirm correct placement can result in treatment failure and puts the patient at risk.Indeed, this is why option 1 from the original exercise, which suggests verifying placement after administering medications, is deemed inappropriate.

Medication Administration Techniques

When administering medications through a gastrostomy tube, it is important to consider the correct techniques to maintain drug efficacy and patient safety.

• Separate administration: Each crushed or liquid medication should generally be administered individually. Mixing them can lead to chemical interactions that might reduce effectiveness or cause side effects.


• Flushing the tube: After each medication dose, flush the tube with an adequate amount of water. This ensures the entirety of the medication is delivered and prevents tube blockage.


• Temperature of flush water: Use room temperature water for flushing. Water that is too cold can cause discomfort to the patient.

Incorrect administration methods, such as mixing all medications together, as suggested in option 2 of the original exercise, should be avoided. This underscores the need for careful individual drug dosing and considerate measure of water temperature.

Gastric Residual Check

Before administering medications via gastrostomy tube, a gastric residual check is an essential procedure. This helps assess the digestive readiness of the patient.

• Purpose: This procedure measures the amount of content still present in the stomach. High residual volumes might indicate digestive issues or slow gastric emptying.


• How to perform: Use a syringe to gently aspirate stomach contents. Measure and evaluate the volume carefully.

If the gastric residual volume is too high, it might be necessary to delay medication administration to prevent complications such as vomiting or aspiration. A proper gastric residual check ensures the stomach is ready for medications or nutrition, making option 5 a vital nursing action.

Patient Positioning After Medication

Patient positioning after administering medications through a gastrostomy tube plays a key role in enhancing the effectiveness and safety of the treatment.

• Elevating the head: Keep the patient’s head elevated for 30 to 60 minutes post-administration. This helps in the natural flow of the medication and prevents reflux.


• Reflux prevention: Elevated head positioning minimizes the risk of medication coming back up into the esophagus, which could cause irritation or aspiration.

This action is a part of best nursing practices to minimize health risks and maximize comfort during medication administration, thereby validating option 6 from the exercise as appropriate. Patient comfort and safety are the primary goals of such positioning techniques.